Breast miwk

Two 25-miwwiwiter sampwes of human breast miwk. The wefdand sampwe is first miwk produced and de righdand sampwe is miwk produced water during de same pumping.

Breast miwk is de miwk produced by de breasts (or mammary gwands) of a human femawe to feed a chiwd. Miwk is de primary source of nutrition for newborns before dey are abwe to eat and digest oder foods; owder infants and toddwers may continue to be breastfed, in combination wif oder foods from six monds of age when sowid foods shouwd be introduced.

The baby nursing from its own moder is de most common way of obtaining breast miwk, but de miwk can be pumped and den fed by baby bottwe, cup and/or spoon, suppwementation drip system, or nasogastric tube. In preterm chiwdren who do not have de abiwity to suck during deir earwy days of wife, avoiding bottwes and tubes, and use of cups to feed expressed miwk and oder suppwements is reported to resuwt in better breastfeeding extent and duration subseqwentwy.[1] Breast miwk can be suppwied by a woman oder dan de baby's moder, eider via donated pumped miwk (generawwy from a miwk bank or via informaw miwk donation), or when a woman nurses a chiwd oder dan her own at her breast, a practice known as wetnursing.

The Worwd Heawf Organization recommends excwusive breastfeeding for de first six monds of wife, wif sowids graduawwy being introduced around dis age when signs of readiness are shown, uh-hah-hah-hah. Suppwemented breastfeeding is recommended untiw at weast age two and den for as wong as de moder and chiwd wish.[2]

Breastfeeding awso provides heawf benefits for de moder. It assists de uterus in returning to its pre-pregnancy size and reduces post-partum bweeding, as weww as assisting de moder in returning to her pre-pregnancy weight. Breastfeeding awso reduces de risk of breast cancer water in wife.[15][16] Lactation protects bof moder and infant from bof types of diabetes.[17] Lactation may protect de infant from specificawwy devewoping Type 2 diabetes because studies have shown dat bioactive ingredients in human breast miwk couwd prevent excess weight gain during chiwdhood via contributing to a feewing of energy and satiety. A wower risk of chiwd-onset diabetes may more appwicabwe to infants who were born from diabetic moders.[14] The reason is because whiwe breastfeeding for at weast de first 6 monds of wife minimizes de risk of Type 1 diabetes from occurring in de infant, inadeqwate breastfeeding in an infant prenatawwy exposed to diabetes was associated wif a higher risk of de chiwd devewoping diabetes water on, uh-hah-hah-hah.[14] However, it can be argued dat human breastfeeding may contribute to protective effects against de devewopment of Type 1 diabetes due to de fact dat de awternative of bottwe-feeding may expose infants to unhygienic feeding conditions.[18]

Though it now is awmost universawwy prescribed, in some countries in de 1950s de practice of breastfeeding went drough a period where it was out of vogue and de use of infant formuwa was considered superior to breast miwk. However, it is now universawwy recognized dat dere is no commerciaw formuwa dat can eqwaw breast miwk. In addition to de appropriate amounts of carbohydrate, protein, and fat, breast miwk provides vitamins, mineraws, digestive enzymes,[19] and hormones.[19] Breast miwk awso contains antibodies and wymphocytes from de moder dat hewp de baby resist infections.[20] The immune function of breast miwk is individuawized, as de moder, drough her touching and taking care of de baby, comes into contact wif padogens dat cowonize de baby, and, as a conseqwence, her body makes de appropriate antibodies and immune cewws.[21]

At around four monds of age, de internaw iron suppwies of de infant, hewd in de hepatic cewws of de wiver, are exhausted. The American Academy of Pediatrics recommends dat at dis time dat an iron suppwement shouwd be introduced,[22] however, oder heawf organisations such as de NHS in de UK have no such recommendation, uh-hah-hah-hah.[23] Breast miwk contains wess iron dan formuwa, because it is more bioavaiwabwe as wactoferrin, which carries more safety for moders and chiwdren dan ferrous suwphate.[24]

Bof de AAP[25] and de NHS recommend vitamin D suppwementation for breastfed infants.[23] Vitamin D can be syndesised by de infant via exposure to sunwight, however, many infants are deficient due being kept indoors or wiving in areas wif insufficient sunwight. Formuwa is suppwemented wif vitamin D for dis reason, uh-hah-hah-hah.[23][25]

Actuaw inabiwity to produce enough miwk is rare, wif studies showing dat moders from devewoping countries experiencing nutritionaw hardship stiww produce amounts of miwk of simiwar qwawity to dat of moders in devewoped countries.[26] There are many reasons a moder may not produce enough breast miwk. Some of de most common reasons are an improper watch (i.e., de baby does not connect efficientwy wif de nippwe), not nursing or pumping enough to meet suppwy, certain medications (incwuding estrogen-containing hormonaw contraceptives), iwwness, and dehydration, uh-hah-hah-hah. A rarer reason is Sheehan's syndrome, awso known as postpartum hypopituitarism, which is associated wif prowactin deficiency and may reqwire hormone repwacement.

The amount of miwk produced depends on how often de moder is nursing and/or pumping: de more de moder nurses her baby or pumps, de more miwk is produced.[27][28][29] It is beneficiaw to nurse when de baby wants to nurse rader dan on a scheduwe. A Cochrane review came to de concwusion dat a greater vowume of miwk is expressed whiwst wistening to rewaxing audio during breastfeeding, awong wif warming and massaging of de breast prior to and during feeding. A greater vowume of miwk expressed can awso be attributed to instances where de moder starts pumping miwk sooner, even if de infant is unabwe to breastfeed.[30]

Sodium concentration is higher in hand-expressed miwk, when compared wif de use of manuaw and ewectric pumps, and fat content is higher when de breast has been massaged, in conjunction wif wistening to rewaxing audio. This may be important for wow birdweight infants.[30] If pumping, it is hewpfuw to have an ewectric, high-grade pump so dat aww of de miwk ducts are stimuwated. Gawactagogues increase miwk suppwy, awdough even herbaw variants carry risks; derefore non-pharmaceuticaw medods shouwd be tried first.[31][32]

Breast miwk contains compwex proteins, wipids, carbohydrates and oder biowogicawwy active components. The composition changes over a singwe feed as weww as over de period of wactation, uh-hah-hah-hah.[34]

Cowostrum vs breastmiwk

During de first few days after dewivery, de moder produces cowostrum. This is a din yewwowish fwuid dat is de same fwuid dat sometimes weaks from de breasts during pregnancy. It is rich in protein and antibodies dat provide passive immunity to de baby (de baby's immune system is not fuwwy devewoped at birf). Cowostrum awso hewps de newborn's digestive system to grow and function properwy.

Cowostrum wiww graduawwy change to become mature miwk. In de first 3–4 days it wiww appear din and watery and wiww taste very sweet; water, de miwk wiww be dicker and creamier. Human miwk qwenches de baby's dirst and hunger and provides de proteins, sugar, mineraws, and antibodies dat de baby needs.

In de 1980s and 1990s, wactation professionaws (De Cweats) used to make a differentiation between foremiwk and hindmiwk. But dis differentiation causes confusion as dere are not two types of miwk. Instead, as a baby breastfeeds, de fat content very graduawwy increases, wif de miwk becoming fattier and fattier over time.[35]

The wevew of Immunogwobuwin A (IgA) in breast miwk remains high from day 10 untiw at weast 7.5 monds post-partum.[36]

Breast miwk contains a uniqwe type of sugars, human miwk owigosaccharides (HMOs), which are not present in infant formuwa. HMOs are not digested by de infant but hewp to make up de intestinaw fwora. They act as decoy receptors dat bwock de attachment of disease causing padogens, which may hewp to prevent infectious diseases. They awso awter immune ceww responses, which may benefit de infant. To date (2015) more dan a hundred different HMOs have been identified; bof de number and composition vary between women and each HMO may have a distinct functionawity.[51]

The breast miwk of diabetic moders has been shown to have a different composition from dat of non-diabetic moders. It may contain ewevated wevews of gwucose and insuwin and decreased powyunsaturated fatty acids. A dose-dependent effect of diabetic breast miwk on increasing wanguage deways in infants has awso been noted, awdough doctors recommend dat diabetic moders breastfeed despite dis potentiaw risk.[52]

Women breastfeeding shouwd consuwt wif deir physician regarding substances dat can be unwittingwy passed to de infant via breast miwk, such as awcohow, viruses (HIV or HTLV-1) or medications. Even dough most infants infected wif HIV contract de disease from breastfeeding, most infants dat are breastfed by deir HIV positive moders never contract de disease.[53] Whiwe dis paradoxicaw phenomenon suggests dat de risk of HIV transmission between an HIV positive moder and her chiwd via breastfeeding is smaww, studies have awso shown dat feeding infants wif breast miwk of HIV-positive moders can actuawwy have a preventative effect against HIV transmission between de moder and chiwd.[53] This inhibitory effect against de infant contracting HIV is wikewy due to unspecified factors excwusivewy present in breast miwk of HIV-positive moders.[53]

Most women dat do not breastfeed use infant formuwa, but breast miwk donated by vowunteers to human miwk banks can be obtained by prescription in some countries.[54] In addition, research has shown dat women who rewy on infant formuwa couwd minimize de gap between de wevew of immunity protection and cognitive abiwities a breastfed chiwd benefits from versus de degree to which a bottwe-fed chiwd benefits from dem. This can be done by suppwementing formuwa-fed infants wif bovine miwk fat gwobuwe membranes (MFGM) meant to mimic de positive effects of de MFGMs which are present in human breast miwk.[55]

Expressed breast miwk can be stored. Lipase may cause dawed miwk to taste soapy or rancid due to miwk fat breakdown, uh-hah-hah-hah. It is stiww safe to use, and most babies wiww drink it. Scawding it wiww prevent rancid taste at de expense of antibodies.[56] It shouwd be stored wif airtight seaws. Some pwastic bags are designed for storage periods of wess dan 72 hours. Oders can be used for up to 12 monds if frozen, uh-hah-hah-hah. This tabwe describes safe storage time wimits.[57]

Aww mammawian species produce miwk, but de composition of miwk for each species varies widewy and oder kinds of miwk are often very different from human breast miwk. As a ruwe, de miwk of mammaws dat nurse freqwentwy (incwuding human babies) is wess rich, or more watery, dan de miwk of mammaws whose young nurse wess often, uh-hah-hah-hah. Human miwk is noticeabwy dinner and sweeter dan cow's miwk.

Awmost aww medicines pass into breastmiwk in smaww amounts. Some have no effect on de baby and can be used whiwe breastfeeding.[67] Women wif hypodyroidism may be unabwe to produce miwk.[68][69] Awcohow use during pregnancy carries a significant risk of serious birf defects, but consuming awcohow after de birf of de infant is considered safe.[70]

There is a market for human breast miwk, bof in de form of wet nurse service and miwk product. As a product, breast miwk is exchanged by human miwk banks as weww as directwy between miwk donors and customers mediated by websites on de Internet. Human miwk banks generawwy have standardized measures for screening donors and storing de miwk, whiwe donors on websites vary in regard to dese measures. A study in 2013 came to de concwusion dat 74% of breast miwk sampwes from providers found from websites were cowonized wif Gram-negative bacteria or had more dan 10,000 cowony-forming units/mL of aerobic bacteria.[72] Growf happens during transit.[72] According to de FDA, de bacteria in fresh miwk doubwes every 20 minutes.[73] Breast miwk is considered to be heawdier dan cow's miwk and infant formuwa when it comes to feeding an infant in de first 6 monds of wife, but onwy under extreme situations do internationaw heawf organizations support feeding an infant breast miwk from a heawdy wet nurse rader dan dat of its biowogicaw moder.[74] One reason is because de unreguwated breast miwk market is fraught wif risks such as drugs of abuse and prescription medications being present in donated breast miwk.[74] The transmission of dese substances drough breast miwk can do more harm dan good when it comes to de heawf outcomes of de infant recipient.[74]

A minority of peopwe, incwuding restaurateurs Hans Lochen of Switzerwand and Daniew Angerer of Austria, who operates a restaurant in New York City, have used human breast miwk, or at weast advocated its use, as a substitute for cow's miwk in dairy products and food recipes.[75][76] An Icecreamist in London's Covent Garden started sewwing an ice cream named Baby Gaga in February 2011. Each serving cost £14. Aww de miwk was donated by a Mrs Hiwey who earned £15 for every 10 ounces and cawwed it a "great recession beater".[77] The ice cream sowd out on its first day. Despite de success of de new fwavour, de Westminster Counciw officers removed de product from de menu to make sure dat it was, as dey said, "fit for human consumption, uh-hah-hah-hah."[78]Tammy Frisseww-Deppe, a famiwy counsewwor speciawized in attachment parenting, pubwished a book, titwed A Breastfeeding Moder's Secret Recipes, providing a wengdy compiwation of detaiwed food and beverage recipes containing human breast miwk.[79] Human breast miwk is not produced or distributed industriawwy or commerciawwy, because de use of human breast miwk as an aduwt food is considered unusuaw to de majority of cuwtures around de worwd, and most disapprove of such a practice.[80]

Whiwe dere is no scientific evidence dat shows dat breast miwk is more advantageous for aduwts dan cow's miwk, according to severaw 2015 news sources breast miwk is being used by bodybuiwders for its nutritionaw vawue. In a February 2015 ABC News articwe one former competitive body buiwder said, "It isn’t common, but I’ve known peopwe who have done dis. It’s certainwy tawked about qwite a bit on de bodybuiwding forums on de Internet." Cawwing bodybuiwders "a strange breed of individuaws,” he said, “Even if dis type of ding is compwetewy unsupported by research, dey’re prone to gym wore and wiwwing to give it a shot if dere is any potentiaw effect.” At de time de articwe was written, in de U.S. de price of breast miwk procured from miwk banks dat pasteurize de miwk, and have expensive qwawity and safety controws, was about $10 an ounce, and de price in de awternative market onwine, bought directwy from moders, ranges from $1 to $4 per US fwuid ounce, compared to cow's miwk at about $3.44 a gawwon, uh-hah-hah-hah.[81][82]

A 2015 CBS articwe cites an editoriaw wed by Dr. Sarah Steewe in de Journaw of de Royaw Society of Medicine, in which dey say dat "de heawf cwaims do not stand up cwinicawwy and dat raw human miwk purchased onwine poses many heawf risks." CBS found a study from de Center for Biobehavioraw Heawf at Nationwide Chiwdren's Hospitaw in Cowumbus dat "found dat 11 out of 102 breast miwk sampwes purchased onwine were actuawwy bwended wif cow's miwk." The articwe awso expwains dat miwk purchased onwine may be improperwy sanitized or stored, so it may contain food-borne iwwness and infectious diseases such as hepatitis and HIV.[83]

^Department of Heawf, 1994. Weaning and de weaning diet. Report of de Working Group on de Weaning Diet of de Committee on Medicaw Aspects of Food Powicy. London: HMSO. Report on Heawf and Sociaw Subjects No 45.

^"Breastfeeding"(PDF). Office on Women’s Heawf, U.S. Department of Heawf and Human Services. 2014. Retrieved 20 Juwy 2017.This articwe incorporates text from dis source, which is in de pubwic domain.

^"Tyroid disease in Women". Office on Women’s Heawf, U.S. Department of Heawf and Human Services. 1 February 2017. Retrieved 20 Juwy 2017.This articwe incorporates text from dis source, which is in de pubwic domain.